title: Comparative outcomes of younger and older hospitalized patients with inflammatory bowel disease treated with corticosteroids.
abstract: BACKGROUND
  Data on the differences in inpatient treatment approaches and outcomes between younger and older patients with inflammatory bowel disease (IBD) are limited. Therefore, we used a parallel cohort study design to compare outcomes between younger and older patients with IBD.
  
  
  METHODS
  All anti-tumor necrosis factor (TNF)-naive patients aged 60 years and older hospitalized at our institution between 2003 and 2011 and treated with corticosteroids for an IBD flare were matched 1:1 to younger patients aged 18 to 50 years. Rates of corticosteroid response, colectomy, and initiation of anti-TNF therapy were compared.
  
  
  RESULTS
  Sixty-five patients were identified in each cohort. Median ages were 70 years (range, 60-94) and 30 years (range, 18-50) for the older and younger groups, respectively. Twenty-three percent of older patients were refractory to corticosteroids compared with 38% of the younger cohort (odds ratio, 0.5; 95% confidence intervals, 0.2-1.1). Older corticosteroid-refractory patients had surgery (80% versus 72%) and were started on anti-TNF therapy (20% versus 12%; P = 0.71), at a similar frequency as younger patients. Older steroid-responsive patients were less likely to start an anti-TNF agent during the first year of follow-up than younger patients (7% versus 31%, P = 0.006), but there was no difference in 1-year colectomy rates (27% versus 28%, P = 0.63).
  
  
  CONCLUSIONS
  Corticosteroid response was similar in older and younger patients hospitalized for IBD. Inpatient treatment for corticosteroid-refractory patients was similar between cohorts. Older corticosteroid-responsive patients were less likely to be treated with an anti-TNF than younger patients.
authors.affiliation: *Division of Gastroenterology and Hepatology and †Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Weber
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: William J
authors.initials: WJ
authors.lastname: Tremaine
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Augustin
authors.forename: Brenda D
authors.initials: BD
authors.lastname: Becker
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Kammer
authors.forename: William Scott
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones